Routine inspection·August 6, 2025

On 8/6/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct their annual inspection visit. LPA met with one of the staff on duty and stated the purpose of the visit. The current administrator Grant Depositar was notified and arrived shortly after. Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 non-ambulatory residents, ages 60 and above. Facility has hospice waiver for 4 residents. Facility has 6 resident bedrooms and three bathrooms, and one staff room. Bedroom #2 on the facility sketch was approved for bedridden use. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 5 of 6 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout. LPA measured the hot water temperature in the 1 of 3 bathrooms to be at 117 degrees Fahrenheit. Bathrooms were observed to be in clean. The hallway bathroom sink cabinet was observed to be not locking properly. Advisory was provided to fix the lock. Room temperature was at 76 degrees Fahrenheit.Fire extinguisher was observed and last inspected on 2/6/2025. Smoke and carbon monoxide detectors were observed throughout. In the kitchen area, LPA observed sufficient seven day non-perishable and two day perishable food supplies. Pantry was observed to be fully stocked with non-perishable food items. Insect spray was observed stored in the pantry. LPA observed a Rubitussin medication inside the kitchen refrigerator. Staff immediately placed the medication in a locked area. {Con't to 809-C} {Con't from 809} The garage can be access and unlock from the inside. Garage houses additional refrigerator and freezers. Cleaning solutions and laundry supplies were observed to be accessible to residents. Outdoor area was inspected. LPA observed a covered area for resident use. Ramps were observed to be in good repair at this time. Emergency walkways were observed to be unobstructed. Fence at the garage side of the house was observed to be slightly leaning. Advisory was provided to address this. Record Reviews: Review of 3 of 3 resident files (R1, R2, R3) was conducted, include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. No issues were noted at this time. Medication review of 2 residents (R1, R2) include review of physician orders for over-the-counter medications. No issues were noted at this time. Review of 3 staff files (S1, S2, S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. LPA also reviewed fire drill/disaster drill records; facility conducts quarterly drill. LPA requested a copy of current Liability Insurance Certificate, LIC500 and LIC308 during this visit. Interviews: LPA interviewed 1 staff and 2 residents in care. Case Management LPA Follow up on death report on 4/28/25. Per review, resident (R4) was on hospice due to medical condition (M1). R4 was on hospice since 4/19/24. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were cited. Exit interview was conducted with S1. A copy of the report was provided upon exit.